Disorders of Childhood and Adolescence

1. Disorders of Childhood and Adolescence

2. Disorders of Childhood and Adolescence • Studies in the United States and New Zealand suggest prevalence 17-22% • More boys are diagnosed with childhood disorders than girls. • Girls are more likely to have internalized problems (anxiety and depression) and boys are more likely to have externalized problems (ADHD, conduct disorder, etc…) • ADHD and Separation Anxiety are most common.

3. Maladaptive Behaviors in Different Life Periods • Developmental Psychopathology- Must be taken in the context of normal developmental changes. • Varying Clinical Picture (short lived and less specific than adult disorders) • Some childhood disorders may severely affect future development (ADHD & I.Q. also excess mortality associated with CD) • Vulnerable due to less self-understanding.

4. Disorders of Childhood • ADHD • Conduct Disorder and Oppositional Disorder • Anxiety Disorders • Symptom Disorders • Autism

5. Attention Deficit Hyperactivity Disorder • Characterized by difficulties that interfere with effective task-oriented behavior in children. • Often score 7-15 I.Q points below average • Hyperactive children are the most frequent psychological referrals to mental health and pediatric facilities. • 6-9% more prevalent with boys than girls • Occurs with greatest frequency before age 8 • Most frequent psychological referral to mental health facilitiies

6. ADHD Criteria • Either (1) or (2): • six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: • often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities • often has difficulty sustaining attention in tasks or play activities • often does not seem to listen when spoken to directly • often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) • often has difficulty organizing tasks and activities • often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) • often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) • is often easily distracted by extraneous stimuli • is often forgetful in daily activities

7. Hyperactivity • often fidgets with hands or feet or squirms in seat • often leaves seat in classroom or in other situations in which remaining seated is expected • often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) • often has difficulty playing or engaging in leisure activities quietly • is often "on the go" or often acts as if "driven by a motor" • often talks excessively • Impulsivity • often blurts out answers before questions have been completed • often has difficulty awaiting turn • often interrupts or intrudes on others (e.g., butts into conversations or games)

8. ADHD Causal Factors • Both biological and environmental • Food additive theory unsupported • Home environment may be a link in that some studies show that parents of ADHD children are more likely to have personality disorders.

9. ADHD Treatments and Outcomes • Both Behavioral Therapy and Medication reduce symptoms. • Medication • 40% of junior high & 15% high school students with emotional and behavioral problems are prescribed medication. • 75% effective rate in treating hyperactive child • Reduces inattention but not impulsivity. • Behavioral Treatment • Demonstrates short-term gains. Reduces symptoms. • Hyperactive bx tends to diminish in some children. Impact however may remain (less education, legal problems, etc….)

11. Conduct Disorder & Oppositional Defiant Disorder • Characterized by aggressive or antisocial behavior. • Virtually all who have conduct disorder have oppositional defiant disorder first. • Oppositional Defiant Disorder usually appears by age 6. Conduct Dis. Age 9. • Looks much like adult antisocial personality disorder.

12. Oppositional Defiant Disorder Criteria • A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present: • often loses temper • often argues with adults • often actively defies or refuses to comply with adults' requests or rules • often deliberately annoys people • often blames others for his or her mistakes or misbehavior • is often touchy or easily annoyed by others • is often angry and resentful • is often spiteful or vindictive

13. Conduct Disorder Criteria • A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: Aggression to people and animals • often bullies, threatens, or intimidates others • often initiates physical fights • has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) • has been physically cruel to people • has been physically cruel to animals • has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) • has forced someone into sexual activity [Continued Next Page]

14. Destruction of property • has deliberately engaged in fire setting with the intention of causing serious damage • has deliberately destroyed others' property (other than by fire setting) • Deceitfulness or theft • has broken into someone else's house, building, or car • often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) • has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) • Serious violations of rules • often stays out at night despite parental prohibitions, beginning before age 13 years • has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) • is often truant from school, beginning before age 13 years • The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

15. Causal Factors: Conduct Disorders • Self-Perpetuating Cycle • Parent-Child relations characterized by rejection and neglect • Conduct Disorder has been associated with divorce, hostility, and lack of monitoring in the family.

16. Treatment • Challenge is parent’s reluctance to become involved in treatment and learn new parenting behaviors.

17. Anxiety Disorders of Childhood • Children typically cope with anxiety by becoming overly dependent on others. • Prevalence is higher in girls than boys. • Separation Anxiety Disorder • Most common childhood anxiety disorder • Essential feature is excessive anxiety about separation from major attachment figures. • Characteristics Include: unrealistic fears, oversensitivity, self-consciousness, nightmares, lack confidence, chronic anxiety, apprehensive in new situations, worry that parents will become ill or die, difficulty sleeping, school refusal problems .

18. Anxiety Disorders: Treatment • Psychopharmacological treatment is questionable in it’s effectiveness • Behavioral Therapy Procedures are Effective • Assertiveness Training, Mastering Competencies, and Desensitization and In Vivo Methods (using graded real life situations) • Group Therapy as a Modality is Effective

19. Childhood Depression • Prevalence greater in girls than boys (2x) • Causal Factors Include: • Biological Factors • Learning Factors • (negative parental behavior, divorce, modeling of depressed mother, marital stress, mother-infant attachment, depressed mothers are less responsive) • Children of depressed mothers are more likely to become depressed themselves and commit suicide • Treatment • Medication is no more effective than placebo • Cognitive-Behavioral Therapy • Providing a supportive emotional environment

20. Treatment Challenges for Childhood Disorders • Most childhood disorders develop out of pathogenic family interactions • Treatment of childhood disorders relies a great deal on teaching parents behavioral therapy interventions • Parents are often key to the child’s treatment and many parents are resistant. • More difficult to get fathers involved than mothers.